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R.G. Beneish, R.C. Polomeno, M.E. Flanders, J.M. Little, R.K. Koenekoop; Occlusion Therapy for Amblyopia: Optimizing Compliance . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2460.
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© ARVO (1962-2015); The Authors (2016-present)
Functional amblyopia can be treated effectively by occlusion of the good eye, providing compliance is good. In an attempt to improve compliance, children with bilateral high ametropias were occluded with a translucent tape on the lens over the preferred eye. We report on the visual outcome of children treated with this type of occlusion.
Eighty–four children presenting with anisometropic, strabismic or deprivation amblyopia were treated with glasses and occlusion of the good eye. The translucent tape reduced visual acuity (VA) to hand motion at .3 meters (m). VA was assessed at .3 and 6 m with Allen pictures, projected Snellen Es or numbers. Fusion was assessed with Worth–4–Dot (WFDT) and Titmus tests.
The mean age at presentation was 3.5 years (range 0.2 – 9.5). The mean initial VA in the amblyopic eye was 20/100 (20/40 – 20/1500) at 6 m and 20/90 (20/40+2 – 20/1500) at .3 m. The mean absolute spherical equivalent was +4.58 diopters (D) (–8.00– +15.00) in the good eye and +5.78 D (–19.00 – +15.00) in the amblyopic eye. Amblyopia was anisometropic (n=26), strabismic (n=37), combined anisometropic /strabismic (n=18) or deprivation (n=1). Initial treatment consisted of full time occlusion (FTO) in 55 patients and part time occlusion (PTO) in 29 patients. Glasses were well worn since most patients were moderate to high ametropes. Occlusion with a translucent tape in 8 patients with poor compliance, improved VA from 20/200 to 20/30. Seven children had an allergic dermatitis to the adhesive patch and were successfully treated with the translucent tape. This response prompted the use of the translucent tape as the initial occluder in 36 patients. The mean final VA at 6m was 20/30+2 (20/20 – 20/70–2) and at 0.3m 20/25 (20/20 – 20/70) in the amblyopic eye. The mean duration of treatment was 13.5 weeks (1 – 45) of FTO, and 16.65 months (1 – 48) of PTO. The mean time elapsed after cessation of occlusion without recurrence was 26.22 months (1 – 160). The mean ocular alignment at distance was 6.2Δ (–35 – +40). WFDT showed fusion in 66 patients. Titmus test showed a mean of 250" of arc (3000 – 40) in 62 patients. Sixty–five (77%) patients attained VA of ≥20/30 and 72 (86%) achieved VA of ≥20/40. Moderate to high ametropia in both eyes was important in enhancing compliance to translucent tape.
The adhesive patch remains the treatment of choice for amblyopia. However, the ease with which the translucent tape was accepted, not only optimized compliance, but also allowed for a longer duration of treatment, perhaps enhancing final visual outcome.
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